Provider Demographics
NPI:1194772921
Name:OBAYOMI, OLATOKUNBO OLUFUNMILAYO (MD)
Entity type:Individual
Prefix:
First Name:OLATOKUNBO
Middle Name:OLUFUNMILAYO
Last Name:OBAYOMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLATOKUNBO
Other - Middle Name:O
Other - Last Name:BARUWA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:100 E CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:800-749-5191
Mailing Address - Fax:
Practice Address - Street 1:100 E CARROLL ST
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:007-749-5191
Practice Address - Fax:410-630-7685
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0043261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF48461Medicare UPIN
MD211NL924Medicare ID - Type Unspecified